Healthcare Provider Details

I. General information

NPI: 1679963284
Provider Name (Legal Business Name): AMY LYNETTE LARSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 6TH ST # 101
LEWISTON ID
83501-2420
US

IV. Provider business mailing address

203 N WASHINGTON ST STE 300
SPOKANE WA
99201-0254
US

V. Phone/Fax

Practice location:
  • Phone: 208-848-8300
  • Fax: 208-848-8303
Mailing address:
  • Phone: 509-434-0359
  • Fax: 509-444-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1532A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: